Stroke is one of the most time-sensitive conditions in all of medicine. Fast treatment is crucial to saving a life. Every minute counts. The quicker a stroke is recognized and the quicker a patient gets treatment, long-term brain damage and/or death can potentially be avoided. Read on to learn about HCA Healthcare’s endeavors to improve human life and stroke care…

Hospitals nationwide measure how fast they provide treatment to stroke patients by what is called door-to-needle (DTN) time. DTN time is the time that it takes caregivers to administer medication that will dissolve a life-threatening blood clot. As the nation’s largest provider of healthcare, HCA Healthcare is not just moving with the tide, but leading it, responding to stroke 30% faster than the national standard.

Stroke guidelines put forth by the American Heart Association/American Stroke Association recommend a DTN time of 60 minutes or less for patients being treated with a “clot-busting” drug called tissue plasminogen activator (tPA). However, studies have found that less than 30% of U.S. patients are treated within this window. HCA Healthcare is currently averaging a DTN time of 42 minutes.

What is a stroke? According to the Centers for Disease Control (CDC), stroke is the fifth-leading cause of death in the United States: the third-leading cause of death for women and the fifth-leading cause of death for men. 750,000 people in the U.S. have a stroke each year and, on average, one in four people worldwide will have a stroke in their lifetime.  A stroke happens when part of your brain dies due to a lack of oxygen-rich blood.
Kevin Orndorff, HCA Healthcare’s vice president of neuroscience

“Our industry leading stroke performance is a product of our talented physicians and hospital teams coupled with the power of HCA Healthcare’s scale,” says Kevin Orndorff, HCA Healthcare’s vice president of neuroscience. “In short, we surveyed our hospitals and analyzed data for the more than 50,000 stroke patients we care for annually to identify best practices, put that information in the hands of the local hospital teams and developed common performance metrics along with goals that exceeded nationally established benchmarks.”

Moving stroke care forward

With 31 recognized comprehensive stroke centers, HCA Healthcare’s talented stroke experts use proven clinical protocols, telemedicine, and coordinated care to provide timely, state-of-the-art service to our patients.

“We also put our scale to work by analyzing market data and partnering with our regional health system leadership to identify community need for additional advanced stroke centers,” adds Orndorff. “Our ‘footprint’ of comprehensive stroke centers has almost doubled over the last three to four years and has enabled us to elevate the stroke care in many of the communities we serve.”

HCA Healthcare’s neuroscience service line has also created a rapid assessment tool based on evidence that can be used in the emergency department (ED) when a patient is first admitted with stroke symptoms. This tool quickly screens potential stroke patients who present significant neurological symptoms within 24 hours of onset symptoms. The rapid assessment tool is comprised of four pillars:

  1. Stroke Alert Activation: an evidence-based screening tool is used to identify positive criteria for focal neurological deficits, or abnormal functioning of specific areas of the body.
  2. “Launch Pad” or “Pit Stop”: all HCA Healthcare facilities have established a designated area within the ED, maintained for the arrival of all stroke alert patients. From there, an ED provider begins an initial assessment determining stability and appropriateness prior to transporting the patient for a computerized tomography (CT) scan. A non-contrast head CT with preliminary interpretation, or “wet read,” is completed within 20 minutes of arrival. In addition, point of care glucose and blood pressure readings are completed on all stroke alert patients prior to transporting to a CT scan.
  3. Stroke Kit: a readily available “stroke kit” is stocked at all HCA Healthcare facilities with supplies necessary for the evaluation/treatment of stroke alert patients.
Dr. Pranav Mehta, chief medical officer of HCA Healthcare’s American Group and vice president, clinical excellence and medical services

4. Decision to Treat & Alteplase Administration: following the completion and preliminary interpretation of the CT scan, clinicians will determine whether to administer intravenous (IV) alteplase, a thrombolytic drug used to treat acute myocardial infarctions (heart attacks) and other severe conditions caused by blood clotting (strokes), which takes place within one hour in 90 percent of suspected ischemic stroke cases. If administered at an HCA Healthcare facility, however, it will be done as quickly as possible, ideally within 45 minutes.

“At the core, our outstanding stroke performance can be attributed to the dedication of HCA Healthcare clinicians and physicians to identify stroke symptoms and deliver the most effective treatment in a timely manner,” said Dr. Pranav Mehta, chief medical officer of HCA Healthcare’s American Group and vice president, clinical excellence and medical services.

Understanding stroke: causes, symptoms

There are two main types of stroke:

  1. Ischemic stroke: A stroke or cerebrovascular accident that occurs when the blood supply to the brain is cut off, depriving it of oxygen and other nutrients. This is the most common type, making up about 87 percent of all strokes.
  2. Hemorrhagic stroke: When a blood vessel leaks or bursts, causing blood to pool in or around the brain, which can lead to brain damage.

A “mini-stroke” is also called a transient ischemic attack (TIA), which occurs when blood flow to the brain is temporarily interrupted. Its symptoms, which can last from a few minutes to a few hours, don’t usually cause permanent damage. However, the risk of having a stroke again within 90 days of a TIA may be as high as 17 percent, with the greatest risk during the first week.

That’s why it’s critical to be evaluated as soon as possible, ideally within an hour of symptoms starting, since you can’t be sure if it’s a TIA or full stroke.

Some conditions that increase your risk of having a stroke include:

  • A previous stroke, “mini-stroke,” or heart attack (one in four stroke survivors have another stroke within five years)
  • High blood pressure
  • High cholesterol
  • Heart disease
  • Atrial fibrillation (fast, irregular heartbeat)
  • Smoking
  • Diabetes
  • Sickle Cell Disease

Acting F.A.S.T. is key

By knowing the signs and symptoms of stroke, you can take quick action and perhaps save a life, even your own. If you think someone may be having a stroke, act F.A.S.T. and do the following simple test:

  • Face – Ask the person to smile; does one side of their face droop?
  • Arms – Ask the person to raise both arms over their head; does one arm drift downward?
  • Speech – Ask the person to repeat a simple phrase; is the speech slurred or strange?
  • Time – If you notice any of these symptoms, call 9-1-1 right away.

How is a stroke treated?

The CDC states that if you get to a medical facility within three hours of the first symptoms of an ischemic stroke, you may get a type of medicine called a thrombolytic to break up blood clots, called tissue plasminogen activator (tPA). This thrombolytic medicine improves the chances of recovering from a stroke.

Studies show that patients with ischemic strokes who receive tPA are more likely to fully recover or have less disability than patients who do not receive the drug and are also less likely to need long-term care in a nursing home. Unfortunately, many stroke victims don’t get to the hospital in time for tPA treatment.

If you think you or a loved one are having a stroke, it is best to not drive yourself to a healthcare facility. Dial 9-1-1 and seek medical attention immediately. Medical professionals can begin life-saving treatment and get you to an  emergency room right away.

HCA Healthcare is one of the nation’s leading providers of healthcare services, comprising 184 hospitals and approximately 2,000 sites of care, including surgery centers, freestanding ERs, urgent care centers, and physician clinics, in 21 states and the United Kingdom. HCA Healthcare is a learning health system that uses its more than 31 million annual patient encounters to advance science, improve patient care and save lives.